Guest Post: Changing Healthcare One SMS at a Time

By Nancy Meyer

When it comes to mHealth, in many ways developing countries are ahead of the U.S., as innovative text-messaging programs bring life-saving information and supplies to remote areas and achieve remarkable results.

Take, for example, the ways SMS programs in Malawi, Zambia, and other parts of Africa are being used today:

• improving health care services at the community level e.g. ChildCount or Project Mwana based on RapidSMS;
• reducing the incidence of malaria throughout Africa through SMS for Life;
• real-time public health promotion e.g.  Project Masiluleke, HIV/AIDS prevention via SMS in South Africa;
• clinical decision support and patient management e.g. via CommCare;
• real-time data collection in the field by HCPs via cloud-based services e.g. EpiSurveyor.

Through open-source software and donated mobile phones, which are recycled and sold to purchase standardized models at a discount, Medic Mobile has made a huge impact in more than 15 countries in getting people into care, monitoring their conditions and alerting clinicians of danger signs; providing feedback and assistance; increasing the immunization rates by alerting mothers when it’s time to take their children for vaccinations; and managing stock levels of essential supplies in remote outposts.

Likewise, in Kerala, India, Dr. SMS is a free SMS-based information access service that provides local addresses and phone numbers of health facilities when the user texts the word “health,” their pin number and health concern to the service. It’s been successful due to the relatively literate population and comparatively sound healthcare infrastructure.

What can U.S. healthcare learn from such successes? Incentive or need, demographics and cultural preferences need to be understood and privacy concerns addressed.

Without symptomatic incentive, adoption of SMS systems by the public is poor, says Richard Fury, MD, of Kaiser Permanente. A key is to address a need of a specific population, such as pregnant women and new mothers, as in the case of Text4Baby, a Johnson & Johnson and U.S. Department of Health supported program that sends health information and links to resources for mothers during their pregnancies and the first year of their child’s life.

SMS could be used for reminders for immunizations that are required every few years, as in: “It has been 10 years since your last tetanus shot, please schedule an appointment–in the meantime steer clear of sharp, rusty objects.”

SMS can facilitate better communication within the healthcare industry, as in texting with one’s physician. Many doctors are using text messages to answer patient questions, give information on how to manage a specific condition and remind patients of appointments or when to take medication. This works as long as physicians safeguard any private information sent via text just as they would in a phone call, to avoid facing lawsuits. Programs such as TigerTextPro, which claim to be HIPAA-compliant, encrypt data so that it stays confidential.

SMS can be used to find the nearby emergency rooms and their waiting times, by sending a special code via SMS, thanks to such services as ER Texting.

Successful programs address a need and deliver it personally. As participants on theInternet, SMS, and Participatory Health panel at the Global Voices Citizen Media Summit in Nairobi pointed out, the most effective programs do not use “blast messaging” model which is as distasteful as spam email, but remain personal and enable users to ask questions directly.

“Text in the City,” an SMS health service developed by Mount Sinai Adolescent Health Center in New York, provides customized birth control reminders, health education messages, and a chat function to 18- to 24-year-olds. A study of the program found that the ability for patients to text questions confidentially and anonymously was popular with many questions requesting information about proper use of birth control. Text messaging may be a valuable and feasible tool to augment health education efforts for adolescents attending a primary care setting, according to researchers, who are conducting further studies to determine the effectiveness of text messaging in improving outcomes of patient adherence to and correct use of birth control methods.

As for demographics, programs would be most popular among 18 to 50 year olds as they use cell phones the most, research shows. But one research report found that teens are picky about texting.

A University of Arizona study of a texting service designed to help teens adopt healthy lifestyles found that teens prefer an active voice that references them and recommends specific, achievable behaviors.  They preferred 1 to 2 messages per day (any more seems too much like spam) and the tone of the message (upbeat, not preachy) was found to be very important for success.

Future research should address scalability of texting interventions, and explore dose associated with changes in knowledge, attitudes, and behaviors, as well as and offer customized message subscription options.

SMS is an excellent platform for healthcare, thanks to its ubiquity: 85 percent of American adults own mobile phones and 80 percent of them use them for texting; it doesn’t have the learning curve that most apps do; and smartphones, while growing in popularity, still only account for 45 percent of the mobile market, according to Pew Research. Innovators are designing systems that deliver essential information and services in a personalized way to select users.

Reporting by John Bath.